Definition

Overflow incontinence—Liquid stool moving around a mass of stool filling the rectum, which then leaks out of the anus.

Passive incontinence—Passage of stool without sensation of needing to go to the bathroom.

Urge incontinence—Inability to delay having a bowel movement.

Causes

Normal bowel function is a coordination of involuntary and voluntary muscles, and a complex network of nerves. The rectum is the last part of the large intestine. It's function is to hold stool until it is ready for passage through the anal canal. As the rectum fills and stretches, it sends nerve signals to the brain, creating the urge to have a bowel movement. The stool moves down into the anal canal to the anal sphincter. The anal sphincter it is made up of involuntary and voluntary muscles that control the passage of stool out of the body.

Fecal incontinence may be the result of:

Structural defects in the anorectal area, which may be present at birth or acquired during life, that reduce bowel function

Weak muscles in the rectum and pelvic floor, which can occur during aging, that reduce the ability to control bowel movements

Anorectal manometry may be done to check the pressure of the anal canal.

Treatment

Treatment depends on what is causing the incontinence. A combination of different treatments may be necessary. It may take some time to find the right treatment. Each method may not work on everyone. Talk with your doctor about the best plan for you. Options may include one or more of the following:

Diet

Your doctor may suggest changes to your diet. You may be referred to a registered dietitian. Examples of dietary changes include:

Eating smaller meals more frequently

Avoiding foods that may trigger
diarrhea,
such as spicy foods or foods with caffeine

Eating more
fiber
and drinking more fluids—if incontinence is due to constipation

Biofeedback

Biofeedback may help improve awareness of sensation, muscle tone, coordination, and other functional changes. It may be used with electrostimulation of specific nerves to cause sphincter contraction. Currently, evidence is inconclusive regarding biofeedback, but it has shown some success.

Bowel Training

A bowel movement schedule can also train your bowels. For example, you can pick several times throughout the day to try to go to the bathroom, such as after meals.

Exercise

Learn how to do
Kegel exercises. These exercises help strengthen the pelvic floor muscles.

Medications

Medications used depend on the cause. They may be in the form of an oral tablet, liquid, topical cream or ointment, or rectal suppository. If fecal incontinence is caused by medications, your doctor may change or stop them. Do not make changes to your medications on your own.

Constipation may be treated with:

Fiber supplements

Stool softeners

Laxatives

Enemas

Diarrhea may be treated with:

Bulking agents that absorb water and form stool, such as fiber supplements

Antidiarrheals, such as loperamide or diphenoxylate

Medications to treat infection

Medications to improve anal sphincter muscle tone

Bile acid sequestrants that absorb excess bile salts before they reach the large intestine to reduce loose stools in people with previous surgery to remove the gallbladder or a section of the small intestine

Surgery

Surgical procedures may be used to treat this condition when other treatments have failed. Examples include:

Bulking agents, such as collagen or stablized hyaluronic acid, can be directly injected into perianal area. These generally have short-term results and may need to be repeated.

Surgical repair of the anal sphincter

Inserting an artificial bowel sphincter that you can open and close as needed

Colostomy for severe cases—disconnects the colon and brings the end through an opening in the abdomen called a stoma

Other Treatments

Other options to manage fecal incontinence may include:

Radiofrequency energy delivery—Temperature-controlled radio energy is delivered during anoscopy to change the muscular structure of the anal canal. It is not clear how effective this treatment is over a long period of time.

Vaginally-inserted balloon—A balloon placed in the vagina can be inflated as needed to increase pressure on the adjacent rectal area.

Anal plugs—Some find success with this method, but they are generally not well-tolerated.

Prevention

To help reduce your chance of fecal incontinence:

Prevent constipation by eating a
high-fiber diet
and drinking plenty of fluids.

Pay attention to your diet and avoid foods that trigger diarrhea.

Treat chronic health conditions as advised.

Try to maintain a regular bowel movement schedule.

Talk to your doctor if you are having trouble with diarrhea or constipation.

Revision Information

This content is reviewed regularly and is updated when new and relevant evidence is made available. This information is neither intended nor implied to be a substitute for professional medical advice. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with questions regarding a medical condition.